Quote of the Week
“I don’t ask why patients lie, I just assume they all do.”
House
P.S. I know this is COMPLETELY negative and inappropriate. They don’t ALL lie. A lot of them will fluff a story or hide the truth. Please feel free to send an example in the comment section. Just for fun.
I admitted a 1 yr old child to the hospital with a severe asthma flare. Her parents SWORE that nobody smoked around her, but she smelled strongly of it. I did a serum cotinine level on her, and it was even higher than someone exposed to second hand smoke!
Doing a newborn exam in the office and the kid reeks of cig smoke. Me: Who smokes?
Parents (looking guilty): we only smoke outside.
Me: she smells like an ashtray, close the windows by your smoking post and don’t smoke in the car.
Grrr
How ’bout this little story of my most recent (blatant) drug seeker: I see this individual in the ED, and look them up on the state database. Based on that, it looks like it is indeed appropriate to prescribe a small amount of narcotics because the most recent (listed) narc prescription should indeed have run out.
So later on, I get a call from a local pharmacy. The patient presented with my script, and wanted to pay cash… Fortunately, the pharmacy recognized from their records that they actually did have Medicaid.
Who would want to pay cash when they have coverage? As it turns out, someone with something to hide! They tried to authorize my prescription through Medicaid, and discovered, LO AND BEHOLD, that the patient had just filled a multiple pill, 30 day prescription for a high dose immediate release narcotic at another pharmacy! (We always suspected, and now I know, that there is a delay in scripts showing up in the state database!)
Needless to say, I authorized them to void my script, and amended the patient’s chart with the new information… Come to think of it, I should have told them to call the police and have the patient arrested for diversion of narcotics!
OMG! I forgot. The phenomena of “Facilitated Addiction” (my name for it). I’d like to get my name attached to this condition as I’ve not seen it in the literature. That is a patient with a significant “legitimate” painful condition. Say something like multiple foraminal stenosises of the spine who spurns procedures like a potentially curative surgery so they can dupe sympathetic docs into prescribing big time narcs. You catch these people because they purposely miss appointments to the specialists and keep asking for narcs along with refusing therapies. I fire these people after they miss two specialty appointments in a row and keep calling for narcs. They will go to multiple docs who will repeat a workup and think they are appropriately palliating the pain until the doc catches on and fires them. The patient then goes on to a “new” doc who starts the process over again. Believe me, this phenomena is out there.
I am not referring to folks who have a terrible condition, follow all the specialty medical advice and are difficult to keep comfortable. Google “anesthesia dolorosa” as an example of a condition like that. It’s a rare one but tough to help a sufferer.
Not to be totally negative but some people are just plain hard to read. The example is the chest pain patient I or the cardiologist can’t pin down by history with an equivocal stress. Gotta do a cath in that case.
I’m convinced some hide symptoms by fear and not always on purpose.
That is a challenge. If someone is going to consciously lie then they suffer the consequences.
I witnessed a night watchman who was 32, not diabetic, and appeared to suffer from “panic attacks”. Had some benign sounding chest pain features and they did a cath. He has a 95% left main stenosis.
He got bypassed. (This was 1980).
Decades ago a study of cardiac patients advised against smoking when readmitted with chest pain responded negatively to the question about smoking. Of those who denied it, nearly one third had cotinine in the urine. They lie.